Nominations to the international Flat Earth Club iFEC.

A dozen years have passed since  the team at University of California, Davis, confirmed by elegant experiment Michel and Weinbaum’s  steady-state Starling principle. Review articles have been published and important advances made in our understanding of the regulation of the plasma volume, which followers of this website understand is a phase of the extracellular fluid circulation. There are, however, many clinical experts on fluid therapy who remain unenlightened. Thus we see published as recently as 2015 the Victorian presumption that

Colloids are solutions of macromolecular solutes that exert a colloid osmotic pressure across the microvascular tissue barrier and retain fluid in the intravascular bed. Colloids efficiently increase vascular volume, preload, cardiac output, and tissue perfusion in volume responsive patients.”

Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Perioper Med (Lond). 2015; 4: 3. Published online 2015 Apr 10. doi:  10.1186/s13741-015-0014-z PMCID: PMC4403901

They go on to make what they call an evidence-based recommendation:

“in major surgery, the use of a goal-directed fluid regimen containing colloid and balanced-salt solutions is recommended. Though a black box warning for the use of starch solutions exists within the US, there is limited data relative to their harm in the perioperative space. Careful consideration should occur in patients with known renal dysfunction and/or sepsis prior to administering starch solutions.”

It is at least a recommendation that will be gratefully received by their corporate sponsors, listed in a footnote of Declarations. For their ongoing denial of the revised Starling principle the famous fourteen calling themselves the international Fluid Optimisation Group (iFOG) are hereby nominated to’s international Flat Earth Club (iFEC).

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